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Showing content from https://pubmed.ncbi.nlm.nih.gov/29507491/ below:

Completing the cervical screening pathway: Factors that facilitate the increase of self-collection uptake among under-screened and never-screened women, an Australian pilot study

. 2018 Feb;25(1):e17-e26. doi: 10.3747/co.25.3916. Epub 2018 Feb 28. Completing the cervical screening pathway: Factors that facilitate the increase of self-collection uptake among under-screened and never-screened women, an Australian pilot study

Affiliations

¹ Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne.
² Ballarat and District Aboriginal Cooperative, Baarlinjan Medical Clinic.
³ Victorian Cytology Service; Department of Pharmacology and Therapeutics, University of Melbourne.
⁴ Victorian Cytology Service, Department of Obstetrics and Gynaecology, University of Melbourne.

PMID: 29507491
PMCID: PMC5832286
DOI: 10.3747/co.25.3916

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Completing the cervical screening pathway: Factors that facilitate the increase of self-collection uptake among under-screened and never-screened women, an Australian pilot study

E McLachlan et al. Curr Oncol. 2018 Feb.

. 2018 Feb;25(1):e17-e26. doi: 10.3747/co.25.3916. Epub 2018 Feb 28. Affiliations

¹ Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne.
² Ballarat and District Aboriginal Cooperative, Baarlinjan Medical Clinic.
³ Victorian Cytology Service; Department of Pharmacology and Therapeutics, University of Melbourne.
⁴ Victorian Cytology Service, Department of Obstetrics and Gynaecology, University of Melbourne.

PMID: 29507491
PMCID: PMC5832286
DOI: 10.3747/co.25.3916

Item in Clipboard

Abstract

Objectives: To examine factors that enhance under-screened and never-screened women's completion of the self-collection alternative pathway of the Renewed National Cervical Screening Program (ncsp) in Victoria, Australia.

Background: With the Australian ncsp changing, starting on 1 December 2017, the Medical Services Advisory Committee (msac) recommended implementing human papillomavirus (hpv) testing using a self-collected sample for under-screened and never-screened populations. In response, a multi-agency group implemented an hpv self-collection pilot project to trial self-collection screening pathways for eligible women.

Methods: Quantitative data were collected on participation rates and compliance rates with follow-up procedures across three primary health care settings. Forty women who self-collected were interviewed in a semi-structured format, and seven agency staff completed in-depth interviews. Qualitative data were used to identify and understand clinical and personal enablers that assisted women to complete self-collection cervical screening pathways successfully.

Results: Eighty-five per cent (10 women) of participants who tested positive for hpv successfully received their results and completed follow-up procedures as required. Two remaining participants also received hpv-positive results. However, agencies were unable to engage them in follow-up services and procedures. The overall participation rate in screening (self-collection or Pap test) was 85.7% (84 women), with 79 women self-collecting. Qualitative data indicated that clear explanations on self-collection, development of trusting, empathetic relationships with health professionals, and recognition of participants' past experiences were critical to the successful completion of the self-collection pathway. When asked about possible inhibitors to screening and to following up on results and appointments, women cited poor physical and mental health, as well as financial and other structural barriers.

Conclusion: A well-implemented process, led by trusted, knowledgeable, and engaged health care professionals who can provide appropriate support and information, can assist under-screened and never-screened women to complete the hpv self-collection pathway successfully.

Keywords: cervical screening; cultural and linguistically diverse; hpv self-collection; indigenous; women.

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Figures
FIGURE 1

Overview of the self-collection screening…

FIGURE 1

Overview of the self-collection screening pathway. *This pilot was implemented before Renewal when…

FIGURE 1

Overview of the self-collection screening pathway. *This pilot was implemented before Renewal when the National Cervical Screening Program recommended Pap tests every two years for women aged 18 to 69 years. **Recommended but not necessarily implemented upon Renewal. This action was specifically taken to oversee the pilot project. ***Under-screened women in Renewal will be defined as aged 30 to 74 years and two years over the routine screening interval of five years. ****Under Renewal, a CST will be offered (a practitioner-administered hpv test). CST = cervical screening test; HPV = human papillomavirus

FIGURE 2

Participation rates, results, and compliance…

FIGURE 2

Participation rates, results, and compliance with follow-up procedures. This figure shows the number…

FIGURE 2

Participation rates, results, and compliance with follow-up procedures. This figure shows the number of women who were invited to participate in self-collection, the results that were received, and the numbers of participants that continued through follow-up procedures (LBC, colposcopy, and repeat self-collection). *Recommended routine screening interval of five years with CST. ** Were recalled; however could not be engaged in follow-up. ***Variation of the screening pathway as women were allowed to repeat self-collection rather than the recommended speculum examination (LBC). CST = cervical screening test; HPV = human papillomavirus; LBC = liquid-based cytology; Not 16/18 = HPV types that are either non-cancer causing, or much less likely to cause cancer; 16/18 = 70% of cervical cancer and pre-cancerous lesions are caused by HPV types 16 or 18; LSIL = low-grade squamous intraepithelial lesion; HSIL = high-grade squamous intraepithelial lesion; Negative = no cancerous cells detected.